HealthScribe needs no introduction. Incorporated in 1992 as an offshoot of Kriya Systems and headquartered in Sterling, Virginia; HealthScribe, Inc. was started with the intent of providing assistance and support to the healthcare industry through its proprietary transcription technology. HealthScribe pioneered the Medical Transcription industry in India when it commenced its operations in Bangalore in early 1994 through HealthScribe India, a 100% subsidiary. It also operates through a joint venture with Comat Technologies in Mysore. You can visit https://www.healthscribe.com/ and https://www.healthscribeindia.com/ for more info on HealthScribe. HealthScribe India has been encouraging to MT India's efforts in spreading the word, by discussing threadbare issues that are affecting the MT industry in India. The following is based on excerpts from a tete-a-tete with Mr. RamDas Singh Khalsa, Project Manager, HealthScribe India Pvt. Ltd. at Bangalore.

HealthScribe has been one of the pioneers in successfully demonstrating the MT rightsourcing model in India. Yet we do see failures around us. We asked Mr. RamDas Singh Khalsa about what he thought were HealthScribe's strengths and what he perceived to be the bottleneck in this outsourcing model. ''Our model is founded on having our own infrastructure in the United States. In the long run, it will be very difficult for any medical transcription company in India to succeed without also having a strong infrastructure in the United States. HealthScribe has its own sales team and customer service representatives and also a large number of medical transcriptionists in the United States. We are not dependent on any other company to provide us with our work. We provide our customers with easy accessible customer service.'' Mr Khalsa stressed, and went on to add '' Before anyone enters into business, any business, he or she should have a clear plan on how the business will be attracting its customers. An MT business with highly trained MTs and very sophisticated equipment and software will still fail without work. It is critical that every MT company establishes a clear path to attracting customers before doing anything else.''

There has been a lot of hype being attached to MT being an IT enabled service in India. To quote Mr Dertouzos (MIT), that's akin to calling accounting as pencil-enabled services. This has somehow spread the misconception that MT is basically a data entry job. We discussed in length the core skills required. ''Medical transcription does require certain skills and significant amounts of training. Only persons whose English skills are at least equivalent to those of a United States high school graduate (12th year, 9th month on the TOEFL scale) should enter medical transcription training. There are many other qualities that a potential trainee should possess, but minimum skills in English are most important,'' Mr Khalsa highlighted. He went on to add that in addition to all the medical terminology and MT skills needed to be assimilated during training, all trainees need extensive improvement in their English skills. In addition, they all need ample familiarization with American usage and euphemisms. In India, for the majority English is a second language. Medical Transcription training programs from the United States are designed for persons for whom English is the first language. Training programs in India must be modified to accommodate for this variance in order to suitably train transcriptionists. Doctors in the United States may be understanding of occasional errors in difficult medical terminology, but never accept errors in English or American usage, he explained.

Investment required in developing intangible assets in the form of human resources does effect the scalability of this business model in India. Many big Indian business houses when stepping into this industry quote that they would be training and employing above 1,500 MTs on location within six months. The same has also been endorsed as feasible by neutral non-profit and semi-government organizations. We attempted to imbibe from ground realities and HealthScribe's experience. ''Our experience over the last five years has taught us at HealthScribe that the ideal size of an incoming class of trainees is about 50 persons. By outsourcing the classroom portion of our training program to NEXT, we are presently able to start a new class of 50 persons each month. It has taken us quite some time to be able to get to the point where we have enough qualified trainers to grow at this pace.'' informed Mr Khalsa.

Training is the basic criteria, which sets apart an MT whether in India or the US. However many unscrupulous parties are offering mediocre training at high costs. How does one grade a training establishment, we queried of Mr Khalsa. '' In the past month, I have come across two Bangalore training facilities which charged around Rs.15,000 per person for training with a guaranteed job at Rs.5,000 per month following training. In both cases, the fees were collected, training of questionable quality was given, but there was no job. Now the trainees are out a lot of money, don't know if they are really properly trained and have no job. This is tragic for the MTs. If I knew how to get the message out, I would, '' he responded. His message to all new aspirants looking towards MT as a career is:'' Be extremely thorough in checking out a potential training school before handing over any money. I would want to know as much as possible about the financial stability of the organization as well as the qualifications of the trainers. Many persons have opened weakly financed training schools because they couldn't afford to open a production center. All I can suggest is be extremely careful. Don't accept training schools merely on their word, do all the checking you can.''

We proceeded to discuss career options for an MT. In a large company, such as HealthScribe, there are a variety of career paths for transcriptionists, he informed. Some of them may remain contented as successful medical transcriptionists. A medical transcriptionist who consistently produces large volumes of excellent quality work is appropriately compensated financially. Some medical transcriptionists become full-time proofreaders. Others become team leaders (managers) while some move into training.

We asked him to share his perceptions on how continuous speech recognition and formatted electronic records might have an impact on this industry. '' The medical transcription industry should not consider technological advances as a threat,'' Mr Khalsa said. Instead, they should be considered as an opportunity for growth of the industry. At present, voice recognition software has not been developed to the extent that is in wide usage in any industry. As this technology further matures, transcriptionists will be able to use it to increase their personal productivity. It is unlikely that many doctors in the United States will be willing to take the time that would be required to personalize word processing software for their own vocabulary and their own voice. Large hospitals may not be willing to devote huge amounts of computer memory space for each and every author. However, he conceded that once voice recognition software has been developed to a high degree of sophistication, medical transcription companies would have to incorporate its use by the transcriptionists in order to enhance productivity.

While on technology, we asked if the need to keep abreast of and harness technological advances, meant that the 'work at home' MTs had a bleak future? Mr Khalsa viewed that in order to compete in this industry; MT businesses will need to incorporate the latest advances in technology into their business operations. He pointed out that in the United States, HealthScribe, Inc. employed hundreds of 'work at home' MTs. This was rendered possible by using very sophisticated technology. The most significant aspect of HealthScribe's proprietary software was its ability to keep track of all jobs being transcribed anywhere in HealthScribe's network. '' All HealthScribe MTs must be logged into our database in order to transcribe. This allows us to keep real time track of jobs. Amongst other things, this is very significant in terms of customer service.'' he clarified.

We touched on the issue of resentment amongst MTs in USA about jobs going abroad. Seeing the magnitude of work available and considering scalability of this industry in India, we queried if the outsourcing model would ever be a threat to MTs in US. '' This may be more of an emotional issue rather than a real issue. At present, the demand for medical transcription in the United States greatly exceeds the supply of medical transcriptionists available to do the work. Any qualified medical transcriptionist in the United States who wants a job will find one.'' Mr Khalsa firmly stated.

Our discussion turned to confidentiality issues over the Internet. New regulations in the future would make it mandatory for 128-bit encryption of patient records being transmitted over the Internet to uphold security. We asked Mr. Khalsa for his opinion on whether transcribing in India did pose a greater threat to maintaining privacy than the same being done within the boundaries of the USA. Mr Khalsa pointed out that in his recent State of the Union address to the United States Congress, President Bill Clinton did talk about the need to guarantee the confidentiality of medical records. ''It doesn't matter to where medical records are out-sourced,'' was his considered opinion. ''Once they are out-sourced anywhere in the world, there is an increased risk that confidentiality can be breached. Legislation will soon be passed in the United States that will require state-of-the-art security be in place for all transmissions of medical records. This would require investment by every medical transcription company in expensive software and equipment. Smaller companies might have to close if they cannot afford this sort of additional investment. Before purchasing anything, though, companies will need to 100% sure that what they are using is fully compatible with what is being used by their provider.'' he advised.

As a parting shot we addressed the problem of unsavory characters having jumped into this business as 'consultants', who were giving it a bad name. What steps did he suggest to new entrants and American clients to identify and avoid such entities? ''The best way to avoid being misled in this industry is to take the time to learn all you can about it on your own,'' opined Mr Khalsa. ''The less you are dependent on persons outside your own organization, the less vulnerable you are. I would advise that before anyone retains a consultant or enters into any agreement with any other person or company, you should demand a list of references and then carefully check on every one of those references before making any decision. I'd want to know if the references feel that money spent on a consultant was considered to be money well spent. I'd want to know if the references have consistently received the volume and quality of work they were promised by brokers or others claiming to provide work.'' he suggested.

And savoring an enlightening interaction we bid adieu, promising to return in the near future.

By our special editor
Koramangla, Bangalore.
12 Feb, 2000